Specialist Module in Psychotherapy

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1 A Competency Based Curriculum for Specialist Training in Psychiatry Specialist Module in Psychotherapy Royal College of Psychiatrists Royal College of Psychiatrists 2009

2 SPECIALIST IN PSYCHOTHERAPY Specialists in Psychotherapy work with others to assess, manage and treat children and adults with mental health problems using talking therapies and other psychotherapeutic techniques. They also contribute to the development and delivery of effective mental health services at local, regional and national level. Having completed Core Training, the practitioner may enter Advanced Training in their chosen psychiatric specialty. The outcome of this training will be an autonomous practitioner able to work at Consultant level. This Curriculum outlines the competencies the practitioner must develop and demonstrate before they may be certificated as a Specialist in Psychotherapy. Because this level of clinical practice often involves working in complex and ambiguous situations, we have deliberately written the relevant competencies as broad statements. We have also made reference to the need for psychiatrists in Advanced Training to develop skills of clinical supervision and for simplicity, rather than repeat them for each component in the Good Clinical Care Domain; we have stated them only once, although they apply to each domain and will also apply to all specialties and subspecialties. As in the Core Training Curriculum, the competencies are arranged under the CanMEDS headings as follows: - 1. MEDICAL EXPERT 2. COMMUNICATOR 3. COLLABORATOR 4. MANAGER 5. HEALTH ADVOCATE 6. SCHOLAR 7. PROFESSIONAL 2

3 They are, of course, not discrete and free-standing, but overlap and inter-relate to produce an overall picture of the Psychiatrist as a medical expert. It is important to recognise that these headings are used for structural organization only. The complexity of medical education and practice means that a considerable number of the competencies set out below will cross the boundaries between different categories, as the diagram above illustrates. Moreover, depending on circumstances, many competencies will have additional components or facets that are not defined here. This curriculum is based on meta-competencies and does not set out to define the psychiatrist s progress and attainment at a microcompetency level. To do so would result in a document of quite impracticable length and detail which would almost inevitably require constant revision. 3

4 With these points in mind, this curriculum is based on a model of intended learning outcomes (which are summarised below) with specific competencies given to illustrate how these outcomes can be demonstrated. It is, therefore, a practical guide rather than an all-inclusive list of prescribed knowledge, skills and behaviours. The Specialist modules of the College curriculum, including this one, build on the Core Module Curriculum in two ways. Firstly, Specialty Registrars in Psychiatry all continue to achieve the competencies set out in the Core Module throughout training, irrespective of their psychiatric specialty. This involves both acquiring new competencies, particularly in aspects such as leadership, management, teaching, appraising and developing core competencies such as examination and diagnosis to a high level and, as an expert, serving as a teacher and role model. Secondly, the specialist modules set out those competencies that are a particular feature of each specialty. These include competencies that are specific to that specialty, or that feature more prominently in the specialty than they do elsewhere, or that need to be developed to a particularly high level (mastery level) in specialty practice. 4

5 Certificate of Completion of Training (CCT) TRAINEES PROGRESSION FROM ST1 TO CCT IN PSYCHIATRIC SPECIALTIES Certificate o Core Module REHABILITATION* ADDICTIONS* LIAISON* ADULT FORENSIC LEARNING DISABILITY OLD AGE PSYCHOTHERAPY CHILD & ADOLESCENT ST1 ST2 ST3 ST4 ST5 ST6 *Please use the relevant subspecialty curricula in conjunction with Adult (General and Community) Psychiatry curriculum. 5

6 THE INTENDED LEARNING OUTCOMES Some of the intended learning outcomes set out in the Core Curriculum are not included in this specialty module. However, for consistency, the numbering system for the intended learning outcomes has been left unchanged here. Therefore, there are gaps in the sequence below. Intended learning outcome 1 The doctor will be able to perform specialist assessment of patients and document relevant history and examination on culturally diverse patients to include: Presenting or main complaint History of present illness Past medical and psychiatric history Systemic review Family history Socio-cultural history Developmental history Intended learning outcome 2 The doctor will demonstrate the ability to construct formulations of patients problems that include appropriate differential diagnoses Intended learning outcome 3 The doctor will demonstrate the ability to recommend relevant investigation and treatment in the context of the clinical management plan. This will include the ability to develop and document an investigation plan including appropriate medical, laboratory, radiological and psychological investigations and then to construct a comprehensive treatment plan addressing biological, psychological and socio-cultural domains 6

7 Intended learning outcome 4 Based on a comprehensive psychiatric assessment, the doctor will demonstrate the ability to comprehensively assess and document patient s potential for self-harm or harm to others. This would include an assessment of risk, knowledge of involuntary treatment standards and procedures, the ability to intervene effectively to minimise risk and the ability to implement prevention methods against self-harm and harm to others. This will be displayed whenever appropriate, including in emergencies Intended learning outcome 5 Based on the full psychiatric assessment, the doctor will demonstrate the ability to conduct therapeutic interviews; that is to collect and use clinically relevant material. The doctor will also demonstrate the ability to conduct a range of individual, group and family therapies using standard accepted models and to integrate these psychotherapies into everyday treatment, including biological and socio-cultural interventions Intended learning outcome 6 The doctor will demonstrate the ability to concisely, accurately and legibly record appropriate aspects of the clinical assessment and management plan Intended learning outcome 7 To be able to carry out specialist assessment and treatment of patients with chronic and severe mental disorders and to demonstrate effective management of these disease states Intended learning outcome 9 To demonstrate the ability to work effectively with colleagues, including team working 7

8 Intended learning outcome 10 Develop appropriate leadership skills Intended learning outcome 11 Demonstrate the knowledge, skills and behaviours to manage time and problems effectively Intended learning outcome 12 Develop the ability to conduct and complete audit in clinical practice Intended learning outcome 13 To develop an understanding of the implementation of clinical governance Intended learning outcome 15 To develop the ability to teach, assess and appraise Intended learning outcome 16 To develop an understanding of research methodology and critical appraisal of the research literature Intended learning outcome 17 To ensure that the doctor acts in a professional manner at all times Intended learning outcome 18 To develop the habits of lifelong learning 8

9 1. MEDICAL EXPERT DESCRIPTION: Medical expertise integrates the knowledge, clinical skills, procedural skills and professional behaviours that are fundamental to excellent patient care. In other words this describes what the psychiatrist needs to do, how they do it, when they do it and the manner in which they work HISTORY, EXAMINATION, INVESTIGATIONS, TREATMENT (THERAPEUTICS) AND RECORD KEEPING Intended learning outcome 1 The doctor will be able to perform specialist assessment of patients and document relevant history and examination on culturally diverse patients to include: Presenting or main complaint History of present illness Past medical and psychiatric history Systemic review Family history Socio-cultural history Developmental history 9

10 1-1a Clinical history Knowledge Skills Attitudes demonstrated through behaviours Demonstrate a knowledge of the principles of clinical supervision and their practical application (NB this competency applies across all the intended learning outcomes and subjects of this domain) Offer psychiatric expertise to other practitioners to enhance the value of clinical assessments (e.g. through clinical supervision) to which the psychiatrist has not directly contributed Display willingness and availability to give clinical supervision to colleagues at all times (NB this competency applies across all the intended learning outcomes and subjects of this domain) Understand the specific tasks of a psychotherapeutic history and the particular information which must be gathered to facilitate assessment and treatment in each of the major modalities of psychotherapy Demonstrate a specialist understanding of cognitive, emotional and behavioural developmental processes in psychological health and psychiatric disorder Elicit information required for each component of a psychiatric history; in situations of urgency, prioritise what is immediately needed; and gather this information in difficult or complicated situations The doctor shall be able to perform specialist psychotherapeutic assessment of patients and document relevant history and examination on culturally diverse patients Apply skills and knowledge in the conduct of patient examination 1-1b Patient examination, including mental state examination and physical examination Knowledge Skills Attitudes demonstrated through behaviours By the completion of training, psychiatrists will be Display an awareness of 10

11 able to identify psychopathology in all clinical situations, including those that are urgent and/or complex complex needs Assess and diagnose patients with multiple and complicated pathologies Intended learning outcome 2 The doctor will demonstrate the ability to construct formulations of patients problems that include appropriate differential diagnoses 1-2a Psychotherapeutic Formulation Knowledge Skills Attitudes demonstrated through behaviours Describe the theoretical basis of psychotherapeutic formulation in each of the major modalities of psychotherapy The doctor will demonstrate the ability to construct formulations of patients problems that develop a well-evidenced, coherent and appropriate case formulation which relates flexibly to relevant theory to deepen understanding of psychopathology and therapeutic possibilities Construct and explain a comprehensive psychological and psychotherapeutic formulation of the patient s difficulties Intended learning outcome 3 The doctor will demonstrate the ability to recommend relevant investigation and treatment in the context of the clinical management plan. This will include the ability to develop and document an investigation plan including appropriate medical, laboratory, radiological and psychological investigations and then to construct a comprehensive treatment plan addressing biological, 11

12 psychological and socio-cultural domains 1-3a Plan and evaluate the outcome of a psychotherapeutic treatment strategy Knowledge Skills Attitudes demonstrated through behaviours Understand the theoretical underpinnings for the planning of psychological treatments in a wide range of contexts Demonstrate the ability to recommend relevant investigation and psychotherapeutic treatment in the context of an overall clinical management plan This should include the capacity to formulate an individually tailored psychological treatment plan for a broad range of disorders and to provide reasoned recommendations for choice of treatment to patients with confidence Final year trainees should demonstrate expertise in advising on and planning treatment for patients with very specialised needs and across a wide range of different therapy types Trainees will demonstrate the ability to evaluate the outcomes of treatments already received or in progress and adjust management accordingly 12

13 Intended learning outcome 4 Based on a comprehensive psychiatric assessment, the doctor will demonstrate the ability to comprehensively assess and document patient s potential for self-harm or harm to others. This would include an assessment of risk, knowledge of involuntary treatment standards and procedures, the ability to intervene effectively to minimise risk and the ability to implement prevention methods against self-harm and harm to others. This will be displayed whenever appropriate, including in emergencies 1-4a Contribute specialist knowledge to the assessment and management of risk Knowledge Skills Attitudes demonstrated through behaviours Understand a psychotherapeutic perspective on risk Use specialist psychotherapeutic knowledge and approach to inform assessment of risk in patients in a range of settings and advise on psychological strategies to predict and minimise risk 1-4b Psychiatric emergencies Knowledge Skills Attitudes demonstrated through behaviours Apply the principles of empathic understanding and a psychologically minded approach to risk assessment and management Independently assess and manage patients with mental illnesses including uncommon conditions, in emergencies Demonstrate expertise in applying Maintain good professional attitudes and behaviour when responding to situations of ambiguity and uncertainty 13

14 the principles of crisis intervention in emergency situations Make care plans in urgent situations where information may be incomplete Provide appropriate psychotherapeutic intervention and support in the aftermath of an emergency Able to provide immediate psychological support following untoward incident Able to undertake reviews of a critical incident with sensitivity to the needs and standpoints of all participants 1-4c Mental health legislation Knowledge Skills Attitudes demonstrated through behaviours Be prepared to give advice to others on the use of mental health and allied legislation 14

15 1-4d Broader legal framework Knowledge Demonstrate awareness of specialist aspects of the law Skills Attitudes demonstrated through behaviours Intended learning outcome 5 Based on the full psychiatric assessment, the doctor will demonstrate the ability to conduct therapeutic interviews; that is to collect and use clinically relevant material. The doctor will also demonstrate the ability to conduct a range of individual, group and family therapies using standard accepted models and to integrate these psychotherapies into everyday treatment, including biological and socio-cultural interventions 1-5a Psychological therapies Knowledge Skills Attitudes demonstrated through behaviours Apply contemporary knowledge and principles in psychological therapies Display the ability to provide expert advice to other health and social care professionals on psychological treatment and care Demonstrate the ability to conduct a range of individual, group and family therapies using standard accepted models and to integrate these psychotherapies into everyday treatment, including biological and sociocultural interventions. Plan psychotherapeutic treatments on the basis of individual formulation predicting probable consequences of treatment and its interaction with other factors in the patient's life Continue to practice and develop a range of treatment skills 15

16 Demonstrate an understanding of mental disorders and how psychodynamic, cognitive behavioural, systemic and integrative therapy theories and models may be applied in practice showing a sensitive appreciation of application of more than one model applied across the full range of psychiatric disorders Demonstrate awareness of current evidence-based treatment guidelines and their range of application. Ability to critically evaluate summary guidance in the light of the methods used Demonstrate an understanding of the factors affecting the appropriate choice of therapist for a patient becoming able to combine published evidence with extensive personal experience in making reasoned choices Demonstrate mastery of the theory, technique and application of a recognised form of psychotherapy (psychodynamic; cognitive-behavioural or systemic) Validated competence in delivery of the treatment (when initiating, sustaining and ending episodes of care). Able to develop a treatment model to meet the needs of specific situations and to use experience gained to enhance the knowledge and skills of other therapists Demonstrate mastery across a broad range of clinical conditions, within a range of common clinical settings; out-patient, in-patient, day settings and across more than one modality (individual, group, family) Demonstrate competence in the theory and technique of two other 16

17 recognised forms of psychotherapy Demonstrate core skills of the chosen approaches and appreciate scope of their application and by applying those skills from these models within integrative packages of care Demonstrate skills in monitoring the process of therapy appropriately Employs watchful sensitivity throughout each session, prompting action based on informed comparisons Able to review entire progress of a treatment accurately 17

18 Intended learning outcome 6 The doctor will demonstrate the ability to concisely, accurately and legibly record appropriate aspects of the clinical assessment and management plan 1-6a Record keeping Knowledge Skills Attitudes demonstrated through behaviours Understand the use of different types and styles of record keeping as appropriate to the modality of therapy under consideration Use process notes, structured testing, audio and videotaped records of sessions and therapies appropriately MANAGING LONG-TERM PSYCHIATRIC ILLNESS Intended learning outcome 7 To be able to carry out specialist assessment and treatment of patients with chronic and severe mental disorders and to demonstrate effective management of these disease states 1-7a Management of severe and enduring mental illness Knowledge Skills Attitudes demonstrated through behaviours Understand the psychological effects of chronic illness on interpersonal relationships and intrapersonal Develop professional alliances with patients over the long-term Develop therapeutic optimism and hope Help professionals from different backgrounds to understand and use psychotherapeutic concepts in managing this patient group Provide psychotherapeutic assessment and specific evidence based interventions for people with 18

19 structures Assist and guide trainees in assessing and managing patients with severe and enduring mental illness Contribute a psychotherapeutic perspective to the multidisciplinary assessment and management of patients with severe and enduring mental illness chronic, disabling and complex mental health problems 3. COLLABORATOR DESCRIPTION: Psychiatrists work in collaboration with many other professionals and agencies. They must therefore develop a thorough understanding of health and social care systems and demonstrate this consistently in their daily practice Intended learning outcome 9 To demonstrate the ability to work effectively with colleagues, including team working 3 9a Clinical teamwork Knowledge Skills Attitudes demonstrated through behaviours Maintain and apply a current working knowledge of the law as it applies to working relationships Demonstrate an understanding of Facilitate the leadership and working of other members of the team Recognise and resolve dysfunction and conflict within teams when it arises Be prepared to question and challenge the performance of other team members when standards appear to be compromised 19

20 the responsibility of the team with regard to patient safety Demonstrate an understanding of how a team works and develops effectively Demonstrate an understanding of time management, values based practice and information management Understand specialist contributions of psychodynamic, systemic and cognitive therapeutic approaches to an understanding of team dynamics Competently manage a service, or a part of the service, alongside consultant trainer Show competence in supervised autonomous working Use effective negotiation skills Be able to work with service managers and commissioners and demonstrate management skills such as understanding the principles of developing a business plan Manage change, with the involvement of service users and carers in teamwork. Utilise team feedback Manage complaints made about services Competently participate in the NHS Appraisal Scheme Able to use psychological understanding 20

21 of groups and group processes to manage difficult emotional situations within clinical teams Able to act as an external consultant to a staff team Explains the consultant's role convincingly giving examples of key consultation tasks Demonstrates how consultant's role and behaviour varies across range of contexts 21

22 4. MANAGER DESCRIPTION: Psychiatrists are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources and contributing to the effectiveness of the service Intended learning outcome 10 Develop appropriate leadership skills 4-10a Effective leadership skills Knowledge Skills Attitudes demonstrated through behaviours Demonstrate an understanding of the differing approaches and styles of leadership Demonstrate an understanding of the role, responsibility and accountability of the leader in a team Understand and contribute to the organization of urgent care in the locality Demonstrate an understanding of the structures of the NHS and social care organisations Demonstrate a range of appropriate leadership and supervision skills including: Coordinating, observing and being assured of effective team working Setting intended learning outcomes Planning Motivating Delegating Organising Negotiating Example setting Mediating / conflict resolution Monitoring performance Be prepared to question and challenge the performance of other team members when standards appear to be compromised Willing to explore and to help other staff explore and develop non traditional and innovative models of psychological treatment provision where needed appropriately and safely 22

23 Demonstrate an understanding of organisational policy and practice at a national and local level in the wider health and social care economy Demonstrate an understanding of the principles of change management Understand the principles of identifying and managing available financial and personnel resources effectively Aware of national and local guidance and developments in relation to the provision of psychotherapy services Demonstrate ability to design and implement programmes for change, including service innovation Displays expertise in employing skills of team members to greatest effect Acts as impartial mediator in conflicts over roles and responsibilities Capable of advising on the implementation of and assisting in implementing local and regional initiatives in psychological treatment provision 23

24 TIME MANAGEMENT AND DECISION MAKING Intended learning outcome 11 Demonstrate the knowledge, skills and behaviours to manage time and problems effectively 4-11b Communication with colleagues Knowledge Skills Attitudes demonstrated through behaviours Demonstrate an understanding of the requirements of outside agencies for reports that are timely, accurate and appropriate Prepare and deliver reports for Mental Health Tribunals, Managers Hearings, Coroners Courts and Courts of Law Understand the roles and responsibilities of an expert witness Produce reports that are comprehensive, timely, accurate, appropriate and within limits of expertise Intended learning outcome 12 Develop the ability to conduct and complete audit in clinical practice 4-12a Audit Knowledge Skills Attitudes demonstrated through behaviours Demonstrate a knowledge of different audit methods Be able to set standards that can be audited Hold a positive attitude to the potential of audit in 24

25 Demonstrate a knowledge of methods of sampling for audit Demonstrate a knowledge of obtaining feedback from patients, the public, staff and other interested groups Demonstrate an understanding of the structures of the NHS and social care organisations (or equivalents) Demonstrate an understanding of quality improvement methodologies Demonstrate an understanding of the principles of change management Be able to measure changes in practice Be able to effectively apply audit principles to own work, to team practice and in a service wide context, including to relevant organisational and management systems Be able to supervise a colleague s audit project evaluating and improving the quality of care Show willingness to apply continuous improvement and audit principles to own work and practice Show willingness to support and encourage others to apply audit principles 25

26 CLINICAL GOVERNANCE Intended learning outcome 13 To develop an understanding of the implementation of clinical governance 4-13a Organisational framework for clinical governance and the benefits that patients may expect Knowledge Skills Attitudes demonstrated through behaviours Demonstrate a knowledge of relevant risk management issues; including risks to patients, carers, staff and members of the public Demonstrate a knowledge of how healthcare governance influences patient care, research and educational activities at a local, regional and national level Demonstrate a knowledge of a variety of methodologies for developing creative solutions to improving services Develop and adopt clinical guidelines and integrated care pathways Report and take appropriate action following serious untoward incidents Assess and analyse situations, services and facilities in order to minimise risk to patients, carers, staff and the public Monitor the safety of services Demonstrate ability to deviate from care pathways when clinically indicated Question existing practice in order to improve service Demonstrate willingness to take responsibility for clinical governance activities, risk management and audit in order to improve the quality of the service Be open minded to new ideas Support colleagues to voice ideas 6. Scholar 26

27 DESCRIPTION: Psychiatrists engage in a lifelong pursuit of mastering their domain of expertise. As learners, they recognize the need for Continuing Professional Development and model and facilitate this for others. Through their scholarly activities, they contribute to the creation, dissemination, application and translation of medical knowledge. As teachers, they facilitate and contribute to the education of students, patients, colleagues and others TEACHING AND EDUCATIONAL SUPERVISION Intended learning outcome 15 To develop the ability to teach, assess and appraise 6-15a The skills, attitudes, behaviours and practices of a competent teacher Knowledge Skills Attitudes demonstrated through behaviours Demonstrate an understanding of the basic principles of adult learning Identify learning styles Identify learning outcomes Use a variety of teaching methods Demonstrate a professional attitude to teaching Demonstrate an understanding of the correct use of a variety of teaching strategies Evaluate learning and teaching events Facilitate the learning process and assess performance Organise educational events 27

28 6-15b Assessment Knowledge Skills Attitudes demonstrated through behaviours Use appropriate, approved assessment methods Be at all times honest when assessing performance Give feedback in a timely and constructive manner 6-15c Appraisal Knowledge Skills Attitudes demonstrated through behaviours Demonstrate an understanding of the principles of appraisal (including the difference between appraisal and assessment) Demonstrate an understanding of the structure of appraisal interviews Conduct appraisal effectively and at the appropriate time Show respect and confidentiality for the appraisee Intended learning outcome 16 To develop an understanding of research methodology and critical appraisal of the research literature 6-16a Research techniques Knowledge Skills Attitudes demonstrated through behaviours Demonstrates an understanding of the research governance framework including Frame appropriate research questions Demonstrate a critical spirit of enquiry 28

29 the implications for the local employer (NHS Trust or equivalent) of research. Demonstrates an understanding of the work of research ethics committees and is aware of any ethical implications of a proposed research study Demonstrate an understanding of how to design and conduct a research study Demonstrate an understanding of the use of appropriate statistical methods Describe how to write a scientific paper Demonstrate a knowledge of sources of research funding Knowledge of the evidence base in psychological treatments including the limitations of this evidence base and the specific methodological issues involved in gathering and evaluating evidence Able to write a research protocol and draw up a realistic time line for the proposed study Able to apply successfully for R & D approval (if relevant) Able to apply successfully to an ethics committee (if relevant) Carry out a research project and able to modify protocol to overcome difficulties. Can adhere to time lines. Enters data onto standard computer software, eg EXCEL, STATA, SPSS etc Able to compare own findings with others Able to prepare research for written publication and follow submission instructions for most appropriate journal Able to present own research at meetings and conferences Able to read and evaluate research on psychological treatments and apply this flexibly and appropriately to clinical Ensure subject confidentiality Work collaboratively in research supervision Demonstrate consistent compliance with the highest standards of ethical behaviour in research practice 29

30 practice Understands the particular complexities of research and audit design and implementation in psychological treatments 6-16b Evaluation and critical appraisal of research Knowledge Skills Attitudes demonstrated through behaviours Able to carry out a thorough literature search, critically analyse existing knowledge, synthesise information and summarise the relevant findings coherently. Able to write a comprehensive literature review of a proposed topic of study Able to communicate clearly and concisely with non-medical professionals, i.e. other members of the multidisciplinary team, and staff from other agencies, regarding the Be able to appreciate the limitations and controversies within the relevant area of scientific literature 30

31 importance of applying research findings in everyday practice. Able to translate research findings to everyday clinical practice. Inclusion of research findings in case summaries and formulations and in letters to medical colleagues. Able to appreciate the scientific unknowns in the relevant field psychiatric practice Adopt the principles of evidence based practice at a service level 31

32 7. Professional DESCRIPTION: The social contract between psychiatrists, patients and society requires that all of the above are brought together through contemporary best practice, high ethical standards and exemplary personal behaviours MAINTAINING TRUST Intended learning outcome 17 To ensure that the doctor acts in a professional manner at all times 7-17a Doctor patient relationship and confidentiality Knowledge Skills Attitudes demonstrated through behaviours Apply a working knowledge of the specific ethical and legal principles which apply particularly to psychotherapeutic relationships Develop a good understanding of the needs for information of a range of agencies Appreciate the different sensitivities of patients to a range of information held about them particularly in relation to Support and advise colleagues (both medical and non-medical) in dealing with complex professional interactions Demonstrate a sensitive and subtle understanding of the nature and importance of boundaries in psychological treatments including understanding the special strength of threats to boundaries in such treatments and the meaning and management of threats Demonstrate a capacity to deal appropriately and 32

33 psychological material Be aware of the principles and legal framework of disclosure Demonstrates working knowledge of current recommendations for conduct of professional relationships in chosen field of psychotherapy, including guidance on confidentiality ethically with boundary violations when they are revealed including special capacities to plan treatments and future actions in the aftermath of such events Advise others (including non-healthcare professionals) on the safe and appropriate sharing of information 7-17d Risk management Knowledge Skills Attitudes demonstrated through behaviours Demonstrate a knowledge of matters such as health and safety policy Work in collaboration with patients and the multi-disciplinary team to enable safe and positive decision-making 33

34 MAINTAINING GOOD MEDICAL PRACTICE Intended learning outcome 18 To develop the habits of lifelong learning 7-18a Lifelong learning Knowledge Skills Attitudes demonstrated through behaviours Understand the opportunities for continuing professional development as a doctor, psychiatrist and psychotherapist and how these may be kept in balance Recognise and use learning opportunities Maintains familiarity with clinical literature relevant to specialist's field of psychotherapy practice and psychotherapy generally Ensures continued personal and professional development through participation in appropriate psychotherapy courses (including use of personal therapy) Uses a personal development plan effectively to ensure clinical work is adequately supported through supervision, experiential learning and programmed teaching Utilise self-reflective practice to address both conscious and unconscious elements (e.g. prejudice, bias and personal feelings) which may limit clinical capacities 34

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